Ethical Issues and Addiction

Abstract

The epidemic of substance abuse continues to pose a significant challenge to clinicians nationwide. Although there is a tendency to simply associate drug abuse with poverty, the problem affects every social stratum gender and race; and pregnant women are no exception. Caring for pregnant, substance-using women and their infants presents complex legal and ethical issues. Debate is ongoing about whether criminal penalties should be imposed on women based solely on their use of alcohol and other drugs during pregnancy. Furthermore, controversies persist about the rights and wishes of pregnant women versus the interests of their fetuses. For health professionals, conflict arises when the pregnant woman chooses behaviors that have the potential to harm the developing fetus. The ethical dilemma arises from competing autonomy-based and beneficence-based obligations to the maternal-fetal dyad. This chapter explores the ethics-based conflicts in the delivery of health care to drug abusing pregnant women.

Examination of Life Satisfaction, Child Maltreatment Potential and Substance Use in Mothers Referred for Treatment by Child Protective Services for Child Neglect and Substance Abuse: Implications for Intervention Planning

“…This finding substantiates the reports of others (Donohue, Azrin, Bradshaw et al, 2014; Lambert, Scheiner & Campell, 2010; Ondersma et al, 2001) that mothers who neglect their children due to drug exposure may require interventions that are distinct from those of mothers who evidence other types of child neglect. The higher levels of safety and control satisfaction the mothers in this study reported may have resulted from greater resources and higher levels of supervision received from CPS caseworkers as compared with mothers who evidenced other types of child neglect.…”

“…Mothers who expose their children to substances have been identified as a distinct group of neglectful mothers (Donohue et al, 2014; Lambert et al, 2010; Ondersma et al, 2001; Pennar, Shapiro & Krysik, 2012). In examining differences in child neglect type (i.e.…”

Under what conditions is it ethical to offer incentives to encourage drug‐using women to use long‐acting forms of contraception?

“…Does a more modest cash incentive necessarily impair an addicted individual's ability to give free and autonomous consent [56]? The answer will be ‘yes’ for those who believe that addiction is a ‘brain disease’ that abolishes the capacity for autonomous decisions.…”

Validity of Self-Reported Drug Use Information Among Pregnant Women

“…Although analysis of drug metabolites provides a more objective measure of recent drug use (Bar-Oz et al, 2003; Jain, et al, 2013; Lange et al, 2014; Musshoff et al, 2006), biomarker testing poses several limitations in the clinical setting. Foremost are the complex ethical issues associated with screening in vulnerable populations, such as pregnant women (Lambert et al, 2010). Biomarker testing can also be costly, and require additional time and resources to obtain results.…”